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Twelfth ClinicopathologicalConference on
Pituitary Disease
ProgrammeAnd
Abstract Book
Wednesday 10th February 2010Royal College of Physicians London
httpsMujahidSaeedcom
Page 3
Twelfth Clinicopathological Conference on Pituitary DiseaseWednesday 10
thFebruary 2010
Royal College of Physicians London
1140 Pituitary FoundationKit Ashley Director
1150 Forum 2Aggressive pituitary casesChairs Dr MV Vanderpump and Miss J Grieve
Case 7 Acromegaly with multiple aggressive recurrences Effectof temozolamide treatmentC Steele IA MacFarlane Mr M Javadpour andDr CDaousi ndash Liverpool
Case 8 A Case of aggressive macroprolactinoma resistant todopamine agonist therapy and masquerading as anastrocytomaTM Barber JAH Wass
Case 9 Temozolomide-induced regression of hepaticmetastases in a Pituitary corticotroph carcinoma withlow O6-methylguanine-DNA-methyltransferase (MGMT)expressionAK Annamalai HBurton NKandasamy DJHalsallKKovacs ADean NAntoun HKCheow SJefferiesVKKChatterjee HLSimpson RWKirollosJDPickard NBurnet and M GurnellCambridge amp Ontario
Case 10 Targeted Radionuclide therapy for metastatic pituitaryCarcinomaNL Fersht MN Gaze J Bomanji SE Baldeweg andMPowell ndash London
Case 11 Pituitary Metastasis ndash Approaches to diagnosis andManagementMA Saeed N Karavitaki and JAH Wass Oxford
1300 Lunch and Posters
httpsMujahidSaeedcom
Page 16
Case 11 Pituitary Metastasis Approaches to Diagnosis and Management
Author(s) MA Saeed N Karavitaki and JAH Wass (Department of Endocrinology Oxford Centre for Diabetes Endocrinology and Metabolism Churchill Hospital Oxford
HistoryA 68-year-old male presented 16-months after a stable post-chemotherapy right upper lobe pulmonary adenocarcinoma with a 2-month history of headaches right-sided visual disturbance low libido and tiredness He denied increased thirst and nocturiaExaminationThere were no signs of hypersecretory endocrine conditions and he had left-sided blindness from previous trauma and right-sided superior temporal quadrantanopia with intact cranial nervesInvestigations1) normal renal and liver function 2) normal adjusted calcium 3) normal IGF-1 4) secondary hypogonadism LH lt01 IUL (15-93) FSH 03 IUL (2-20) and 9am testosterone lt04 nmolL (84-287) 5) secondary hypothyroidism TSH 212 mUL (05-60) and FT4 88 pmolL (115-227) 6) suboptimal short synacthen test (0min 195 nmolL and 30min 506 nmolL (gt580)) and 7) normal prolactinAn MRI brain with gadolinium showed a 2cm x 2cm x 1cm intra and suprasellar poorly enhancing mass with significant compression of the optic chiasm a possible metastasis involving the pituitary and hypothalamusManagementUnder hydrocortisone cover because of the large suprasellar component he had an elective craniotomy to decompress the optic chiasm Histopathology confirmed a metastatic adenocarcinoma from the pulmonary primary lesionPostoperatively he had ACTH deficiency and was replaced with hydrocortisone and required Desmopressin for cranial diabetes insipidusHe received adjuvant pituitary radiotherapy and a bone scan confirmed he had metastasis to the bones for which he received lumbosacral radiotherapyThe patient died 6-months from diagnosis of the pituitary metastasisDiscussion 1 2
Pituitary metastasis is mainly asymptomatic and can be missed due to symptomscommon to advanced malignancy The commonest presentation is diabetes insipidusThe primary sites are usually the breast and the lung (70) Adequate replacementtherapy metastatic tumour resection adjuvant radiotherapy andor chemotherapy areadvised for improved quality of life The median survival time is 6 monthsReferences
1 Komninos J Et Al 2004 Tumors Metastatic to the Pituitary Gland J ClinEndocrinol Metab 89(2)574-580
2 Morita A and Laws ER 1998 Symptomatic pituitary metastases J Neurosurg8969-73
httpsMujahidSaeedcom
Page 3
Twelfth Clinicopathological Conference on Pituitary DiseaseWednesday 10
thFebruary 2010
Royal College of Physicians London
1140 Pituitary FoundationKit Ashley Director
1150 Forum 2Aggressive pituitary casesChairs Dr MV Vanderpump and Miss J Grieve
Case 7 Acromegaly with multiple aggressive recurrences Effectof temozolamide treatmentC Steele IA MacFarlane Mr M Javadpour andDr CDaousi ndash Liverpool
Case 8 A Case of aggressive macroprolactinoma resistant todopamine agonist therapy and masquerading as anastrocytomaTM Barber JAH Wass
Case 9 Temozolomide-induced regression of hepaticmetastases in a Pituitary corticotroph carcinoma withlow O6-methylguanine-DNA-methyltransferase (MGMT)expressionAK Annamalai HBurton NKandasamy DJHalsallKKovacs ADean NAntoun HKCheow SJefferiesVKKChatterjee HLSimpson RWKirollosJDPickard NBurnet and M GurnellCambridge amp Ontario
Case 10 Targeted Radionuclide therapy for metastatic pituitaryCarcinomaNL Fersht MN Gaze J Bomanji SE Baldeweg andMPowell ndash London
Case 11 Pituitary Metastasis ndash Approaches to diagnosis andManagementMA Saeed N Karavitaki and JAH Wass Oxford
1300 Lunch and Posters
httpsMujahidSaeedcom
Page 16
Case 11 Pituitary Metastasis Approaches to Diagnosis and Management
Author(s) MA Saeed N Karavitaki and JAH Wass (Department of Endocrinology Oxford Centre for Diabetes Endocrinology and Metabolism Churchill Hospital Oxford
HistoryA 68-year-old male presented 16-months after a stable post-chemotherapy right upper lobe pulmonary adenocarcinoma with a 2-month history of headaches right-sided visual disturbance low libido and tiredness He denied increased thirst and nocturiaExaminationThere were no signs of hypersecretory endocrine conditions and he had left-sided blindness from previous trauma and right-sided superior temporal quadrantanopia with intact cranial nervesInvestigations1) normal renal and liver function 2) normal adjusted calcium 3) normal IGF-1 4) secondary hypogonadism LH lt01 IUL (15-93) FSH 03 IUL (2-20) and 9am testosterone lt04 nmolL (84-287) 5) secondary hypothyroidism TSH 212 mUL (05-60) and FT4 88 pmolL (115-227) 6) suboptimal short synacthen test (0min 195 nmolL and 30min 506 nmolL (gt580)) and 7) normal prolactinAn MRI brain with gadolinium showed a 2cm x 2cm x 1cm intra and suprasellar poorly enhancing mass with significant compression of the optic chiasm a possible metastasis involving the pituitary and hypothalamusManagementUnder hydrocortisone cover because of the large suprasellar component he had an elective craniotomy to decompress the optic chiasm Histopathology confirmed a metastatic adenocarcinoma from the pulmonary primary lesionPostoperatively he had ACTH deficiency and was replaced with hydrocortisone and required Desmopressin for cranial diabetes insipidusHe received adjuvant pituitary radiotherapy and a bone scan confirmed he had metastasis to the bones for which he received lumbosacral radiotherapyThe patient died 6-months from diagnosis of the pituitary metastasisDiscussion 1 2
Pituitary metastasis is mainly asymptomatic and can be missed due to symptomscommon to advanced malignancy The commonest presentation is diabetes insipidusThe primary sites are usually the breast and the lung (70) Adequate replacementtherapy metastatic tumour resection adjuvant radiotherapy andor chemotherapy areadvised for improved quality of life The median survival time is 6 monthsReferences
1 Komninos J Et Al 2004 Tumors Metastatic to the Pituitary Gland J ClinEndocrinol Metab 89(2)574-580
2 Morita A and Laws ER 1998 Symptomatic pituitary metastases J Neurosurg8969-73
httpsMujahidSaeedcom
Page 16
Case 11 Pituitary Metastasis Approaches to Diagnosis and Management
Author(s) MA Saeed N Karavitaki and JAH Wass (Department of Endocrinology Oxford Centre for Diabetes Endocrinology and Metabolism Churchill Hospital Oxford
HistoryA 68-year-old male presented 16-months after a stable post-chemotherapy right upper lobe pulmonary adenocarcinoma with a 2-month history of headaches right-sided visual disturbance low libido and tiredness He denied increased thirst and nocturiaExaminationThere were no signs of hypersecretory endocrine conditions and he had left-sided blindness from previous trauma and right-sided superior temporal quadrantanopia with intact cranial nervesInvestigations1) normal renal and liver function 2) normal adjusted calcium 3) normal IGF-1 4) secondary hypogonadism LH lt01 IUL (15-93) FSH 03 IUL (2-20) and 9am testosterone lt04 nmolL (84-287) 5) secondary hypothyroidism TSH 212 mUL (05-60) and FT4 88 pmolL (115-227) 6) suboptimal short synacthen test (0min 195 nmolL and 30min 506 nmolL (gt580)) and 7) normal prolactinAn MRI brain with gadolinium showed a 2cm x 2cm x 1cm intra and suprasellar poorly enhancing mass with significant compression of the optic chiasm a possible metastasis involving the pituitary and hypothalamusManagementUnder hydrocortisone cover because of the large suprasellar component he had an elective craniotomy to decompress the optic chiasm Histopathology confirmed a metastatic adenocarcinoma from the pulmonary primary lesionPostoperatively he had ACTH deficiency and was replaced with hydrocortisone and required Desmopressin for cranial diabetes insipidusHe received adjuvant pituitary radiotherapy and a bone scan confirmed he had metastasis to the bones for which he received lumbosacral radiotherapyThe patient died 6-months from diagnosis of the pituitary metastasisDiscussion 1 2
Pituitary metastasis is mainly asymptomatic and can be missed due to symptomscommon to advanced malignancy The commonest presentation is diabetes insipidusThe primary sites are usually the breast and the lung (70) Adequate replacementtherapy metastatic tumour resection adjuvant radiotherapy andor chemotherapy areadvised for improved quality of life The median survival time is 6 monthsReferences
1 Komninos J Et Al 2004 Tumors Metastatic to the Pituitary Gland J ClinEndocrinol Metab 89(2)574-580
2 Morita A and Laws ER 1998 Symptomatic pituitary metastases J Neurosurg8969-73
httpsMujahidSaeedcom
